MMS Flu Advisory: DPH Updates Guidance on Flu Testing

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The Massachusetts DPH on May 22 updated its guidance testing, treatment and phrophylaxis for the H1N1 (swine flu) virus. The full text of the guidance is below.

The total number of confirmed cases in Massachusetts is now 284. Seventy-eight percent are under the age of 21.

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This update is intended to clarify guidance on testing for the novel swine-origin influenza A (H1N1), and to limit the use of testing to those situations where they are most likely to be beneficial. This guidance also gives the website links to the latest antiviral diagnosis, management, treatment and prophylaxis guidelines.

Testing

CDC and Massachusetts Department of Public Health (MDPH) recommend that testing and treatment be focused on those with severe respiratory illness and those at highest risk of complications from influenza.   Individuals with mild illness should be advised to stay at home.  They do NOT need to be tested or treated unless they meet one of the high-risk criteria listed below.

Specimens should only be submitted to the Hinton State Laboratory Institute (HSLI) for testing for patients in the following situations:

  • Those with flu-like febrile respiratory illness or sepsis-like syndrome requiring hospitalization
  • Those at high risk of complications with influenza and who are exhibiting more serious signs of influenza like illness.  Such groups include:
    • Children < 2 years old
    • Persons > 65 years
    • Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
    • Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
    • Pregnant women;
    • Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy who might be at risk for experiencing Reye syndrome after influenza virus infection;

New:

For individuals with asthma or other high risk conditions who are experiencing mild illness, a rapid influenza test may be performed.  If the result it positive, no further testing for novel influenza A (H1N1) is needed and appropriate treatment should be initiated.

Specimen Collection

Clinicians and laboratories should always contact an MDPH epidemiologist at 617-983-6800 (available 24/7) before submitting specimens. They will be able to assist in guidance for all issues regarding specimen collection and submission guidance, including assistance with transportation of specimens to the HSLI.  We will be posting our latest guidance about specimen collection and other recommendation on the MDPH website at www.mass.gov/dph/swineflu.

Clinical Management and Treatment

Adults and children with fever and one of the following: cough, sore throat or runny nose, should stay home from work or school for at least 7 days from the onset of illness (or 24 hours after the end of illness if symptoms persist longer).   They should not return to work or school before the end of the exclusion period even if asymptomatic because viral shedding can continue for 7 days. A health care provider’s note recommending a child return to school before the end of the full exclusion period does not supercede the public health guidance during this outbreak.  However, individuals who have recovered from influenza-like illness do not need to be “cleared” by a health care provider before returning to work or school after the end of their 7 day exclusion period. 

The latest information for clinicians on identifying and managing patients with influenza A H1N1 infection can be found at: http://www.cdc.gov/h1n1flu/identifyingpatients.htm

The latest information about antiviral treatment and prophylaxis, including new FDA emergency use authorization for the use of antivirals in children < 1 year and pregnant women, can be found at: http://www.cdc.gov/h1n1flu/recommendations.htm

Special Populations

The latest clinical guidance for treating the following special populations can be found on the CDC website:

For additional information from CDC, please go to http://www.cdc.gov/h1n1flu/.

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